Form CMS-855O Revocations

10.3.1.5.5 – Form CMS-855O Revocations (Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25) If the contractor determines that grounds exist for revoking the supplier’s Form CMS-855O enrollment, it shall: (i) Switch the supplier’s PECOS record to a “revoked” status (ii) End-date the PECOS record (iii) Send a letter via certified mail to the supplier stating that the Form CMS-855O enrollment has been revoked. The letter shall follow the format outlined in section 10.7.8 of this chapter. Grounds for revoking the supplier’s Form CMS-855O enrollment are as follows: (i) The supplier is no longer of a type that is eligible to order or certify (ii) The supplier no longer meets the licensure, certification, or educational requirements for the supplier type (iii) The supplier is excluded per the MED and/or debarred per the SAM For purposes of the Form CMS-855O only, the term “revocation” effectively means that: (i) The supplier may no longer order or certify Medicare services based on having completed the Form CMS-855O process. (ii) If the supplier wishes to submit another Form CMS-855O, this must be done as an initial applicant. There are appeal rights associated with the revocation of a supplier’s Form CMS-855O enrollment.